A comparative evaluation of adverse platelet outcomes among Veterans' Affairs patients receiving linezolid or vancomycin.

Abstract

OBJECTIVES The primary objectives were to compare the incidences of severe thrombocytopenia, critical thrombocytopenia and a relative decline in platelets from baseline (≥50% decline) between patients receiving linezolid and those receiving vancomycin. The secondary objective was to assess the relationship between vancomycin trough concentration and adverse platelet outcomes. METHODS A matched cohort study was performed at the Upstate New York Veterans' Affairs Healthcare Network from January 2005 until February 2008. Eligibility criteria were: (i) receipt of linezolid or vancomycin therapy for ≥48 h; (ii) initiation of therapy as an inpatient; and (iii) baseline platelets available for evaluation. Patients who received linezolid were matched 1:1 to patients who received vancomycin. Cumulative incidences and times to event for (i) platelet count ≤50,000 cells/mm(3), (ii) platelet count ≤20,000 cells/mm(3) and (iii) ≥50% decline in platelets from baseline were evaluated. Multivariate analyses were performed. RESULTS The study included 502 patients (251 matched pairs). The occurrences of platelet counts ≤50,000 cells/mm(3) and ≤20,000 cells/mm(3) did not differ significantly between linezolid and vancomycin patients. A ≥50% decline in platelets from baseline was observed in 78 (31.1%) patients receiving vancomycin and 43 (17.1%) patients receiving linezolid (risk ratio 0.55; 95% CI 0.40-0.77). A clear exposure-response relationship was observed between vancomycin trough concentration and ≥50% decline in platelets from baseline. CONCLUSIONS The incidence of thrombocytopenia was low and did not differ significantly among vancomycin and linezolid patients.

DOI: 10.1093/jac/dkr522

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@article{Patel2012ACE, title={A comparative evaluation of adverse platelet outcomes among Veterans' Affairs patients receiving linezolid or vancomycin.}, author={Nimish Patel and H Vandewall and Linda Tristani and Antonio Rivera and Benjamin Kai Pan Woo and Amanda Dihmess and H Karen Li and Raymond P. Smith and Thomas P. Lodise}, journal={The Journal of antimicrobial chemotherapy}, year={2012}, volume={67 3}, pages={727-35} }